Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Washington, Seattle, Washington, USA.
Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA.
Int J Gynecol Cancer. 2024 Oct 7;34(10):1580-1587. doi: 10.1136/ijgc-2024-005567.
To assess clinicopathologic features and survival outcomes of patients with endometrial carcinoma involving adnexal, full-thickness serosal, or combined involvement.
This international, multi-institutional, retrospective study examined patients with 2009 International Federation of Gynecology and Obstetrics (FIGO) stage IIIA endometrial cancer and tumors involving the uterine serosa and/or adnexa, who were surgically staged between 2000 and 2019. Patients with sarcoma histology, concurrent endometrial/ovarian malignancy, neoadjuvant treatment, positive lymph nodes, or peritoneal disease were excluded.
Of 185 patients identified, 139 had tumors with adnexal-only, 40 with serosal-only, and six with combined adnexal/serosal involvement. Median age at diagnosis was 60 years (range 23-89). Among tumors of endometrioid histology, 12 (48%) with serosal-only and 17 (19%) with adnexal-only involvement were FIGO grade 3 (p=0.007). Twenty-three tumors with serosal-only (64%) and 50 with adnexal-only (37%) involvement had lymphovascular invasion (p=0.004). Non-endometrioid histology was present in five tumors (83%) with combined adnexal/serosal, 15 (38%) with serosal-only, and 50 (36%) with adnexal-only involvement.Median follow-up was 77 months (range 0.6-254). Five-year progression-free survival and overall survival rates for all patients with stage IIIA disease were 73.8% (SE 3.5%) and 81.0% (SE 3.1%), respectively. For patients with adnexal-only, serosal-only, and combined adnexal/serosal involvement, 5-year progression-free survival rates were 80% (SE 3.8%), 61% (SE 8.3%), and 33% (SE 19.2%), respectively (p<0.01); 5-year overall survival rates were 85% (SE 3.3%), 70% (SE 7.8%), and 60% (SE 21.9%), respectively (p=0.09). On univariate analysis, tumors having serosal involvement with/without adnexal involvement, non-endometrioid histology, and lymphovascular invasion were significantly associated with progression. On multivariate analysis, tumors having serosal involvement with/without adnexal involvement remained significantly associated with recurrence (adjusted HR=2.2, 95% CI 1.2 to 4.3; p=0.01).
Patients with 2009 FIGO stage IIIA endometrial cancer have distinct survival outcomes depending upon adnexal and/or serosal involvement. Progression-free survival was worse for patients with serosal involvement after adjusting for histology, adjuvant treatment, and lymphovascular space invasion.
评估累及附件、全层浆膜或合并累及的子宫内膜癌患者的临床病理特征和生存结局。
本国际多机构回顾性研究纳入了 2000 年至 2019 年接受手术分期的 2009 年国际妇产科联合会（FIGO）III 期 A 期子宫内膜癌且肿瘤累及子宫浆膜和/或附件的患者。排除肉瘤组织学、同期子宫内膜/卵巢恶性肿瘤、新辅助治疗、阳性淋巴结或腹膜疾病的患者。
在确定的 185 名患者中，139 名患者的肿瘤仅累及附件，40 名患者的肿瘤仅累及浆膜，6 名患者的肿瘤累及附件和浆膜。中位诊断年龄为 60 岁（范围 23-89 岁）。在子宫内膜样组织学肿瘤中，12 例（48%）仅累及浆膜和 17 例（19%）仅累及附件的肿瘤为 FIGO 分级 3（p=0.007）。23 例仅累及浆膜（64%）和 50 例仅累及附件（37%）的肿瘤有血管淋巴管侵犯（p=0.004）。5 例（83%）合并累及附件和浆膜的肿瘤、15 例（38%）仅累及浆膜和 50 例（36%）仅累及附件的肿瘤存在非子宫内膜样组织学。所有 IIIA 期疾病患者的中位随访时间为 77 个月（范围 0.6-254）。所有 IIIA 期疾病患者的 5 年无进展生存率和总生存率分别为 73.8%（SE 3.5%）和 81.0%（SE 3.1%）。对于仅累及附件、仅累及浆膜和合并累及附件和浆膜的患者，5 年无进展生存率分别为 80%（SE 3.8%）、61%（SE 8.3%）和 33%（SE 19.2%）（p<0.01）；5 年总生存率分别为 85%（SE 3.3%）、70%（SE 7.8%）和 60%（SE 21.9%）（p=0.09）。单因素分析显示，浆膜累及伴/不伴附件累及、非子宫内膜样组织学和血管淋巴管侵犯与进展显著相关。多因素分析显示，浆膜累及伴/不伴附件累及与复发显著相关（调整后的 HR=2.2，95%CI 1.2 至 4.3；p=0.01）。
2009 年 FIGO IIIA 期子宫内膜癌患者的生存结局因附件和/或浆膜累及而不同。调整组织学、辅助治疗和血管淋巴管侵犯后，浆膜受累患者的无进展生存率更差。
